骨科英文书籍精读（89）｜肱骨小头骨折
FRACTURED CAPITULUM
This is a rare articular fracture which occurs only in adults. The patient falls on the hand, usually with the elbow straight. The anterior part of the capitulum is sheared off and displaced proximally.
Clinical features
Fullness in front of the elbow is the most notable feature. The lateral side of the elbow is tender and flexion is grossly restricted.
X-Ray
In the lateral view the capitulum (or part of it) is seen in front of the lower humerus, and the radial head no longer points directly towards it. Bryan and Morrey classify these as:
Type I Complete fracture
Type II Cartilaginous shell
Type III Comminuted fracture.
CT scans can be helpful in clarifying the diagnosis.
Treatment
Undisplaced fractures can be treated by simple splintage for 2 weeks.
Displaced fractures should be reduced and held. Closed reduction is feasible, but prolonged immobilization may result in a stiff elbow. Operative treatment is therefore preferred. The fragment is always larger than expected. If it can be securely replaced, it is fixed in position with a small screw. Headless bone screws are ideally passed from front to back; alternatively, if the fragment is large enough, lag screws can be passed from back to front. If this proves too difficult, the fragment is best excised. Movements are commenced as soon as discomfort permits. The longer term outcome is not always good because of stiffness and sometimes instability.
---from 《Apley’s System of Orthopaedics and Fractures》
重点词汇整理：
CAPITULUM /kə'pɪtʃʊləm/n. [组织][生物] 小头，骨端；[植] 头状花序
tender/ˈtendər/adj. 温柔的；（食物）柔软的；疼痛的
grossly /ˈɡroʊsli/adv. 很；非常
Cartilaginous shell软骨壳/ˌkɑːrtɪˈlædʒɪnəs/adj. 软骨的，软骨质的
Headless bone screws 无头骨螺丝
excised /ek'saizd/离体的；切离的
百度翻译：
肱骨小头骨折
这是一种罕见的关节骨折，只发生在成人。 病人以手着地，通常肘部伸直。
小头的前部被剪掉并向近端移位。
临床特征
肘部前面的丰满是最显著的特征。肘关节外侧疼痛，屈曲受到严重限制。
x射线
从侧面看，小头(或小头的一部分)位于肱骨下段前方，桡头不再直接指向小头。Bryan和Morrey将其归类为:
I型完全裂缝
II型软骨外壳
III型粉碎性骨折。
CT扫描有助于明确诊断。
治疗
未移位骨折可采用简单夹板治疗2周。
移位骨折应复位和固定。闭合复位是可行的，但长期固定可能导致肘部僵硬。
因此，手术治疗是首选。碎片总是比预期的大。如果可以安全地更换，则用一个小螺丝将其固定到位。理想情况下，无头骨钉是由前向后传递的;或者，如果碎片足够大，拉力螺钉可以从后到前传递。如果这太困难，最好将碎片切除。只要不舒服就开始运动。长期结果并不总是好的，因为刚度和有时不稳定。